MRSA, Baclofen Pumps, and Mormon Crickets

MRSA, Baclofen Pumps, and Mormon Crickets

Over the years, Deb and I have many times traveled to New Mexico to visit her mother; more often than not, we extend those visits into vacation “road trips” through the western United States. As we drive, we listen to audiobooks or talk about science and medicine (about which we have many theories and scant […]

Over the years, Deb and I have many times traveled to New Mexico to visit her mother; more often than not, we extend those visits into vacation “road trips” through the western United States. As we drive, we listen to audiobooks or talk about science and medicine (about which we have many theories and scant knowledge), politics (about which we are passionate and convinced that we have all the best ideas), and about the price of gasoline (a topic of particular interest to Deb). Several years ago, one of those road trips took us to Idaho to visit an old friend of mine. As we always try to do, we took as many back roads as possible, and at a certain point as we drove along one of those roads, we fell into a comfortable silence and simply enjoyed the extraordinary landscape that surrounded us. On one side were breathtaking mountains and on the other was a lush green valley dotted with sprawling ranches whose back pastures were bordered by more mountains. As I often do when we travel, I lost myself in fantasies of life in the homes I saw. What, I wondered, would it be like to wake each morning and see mountains outside your front and back windows? Where do the people living in those houses work? Where do they shop? What animals and/or vegetation do they raise on those ranches?

Suddenly, though, I was shaken from my daydreams by a scene right out of a B-movie. The mountain to our left was in motion; a huge swarm of red brown bugs marched slowly down its front and made its way toward the highway. The creatures flowed into the road where many had already met their demise; the road was so slick with brown ooze that Deb wondered aloud whether we might slide into a ditch if we attempted to drive over it. Even with what was obviously an extraordinary loss of their numbers to the local motorists who ran blithely over them, the army of bugs seemed as massive on the other side of the road as it did on the mountain itself, and I could see that they were headed directly for a home.

As soon as we arrived at my friend’s house, we described the scene in some depth, both of us certain that she and her family would be as astonished as we had been. We were, however, surprised that their response was one of bored familiarity as they announced, “Oh, those are the Mormon crickets.” Since that summer, my tendency to become intrigued by trivialities has motivated me to read quite a bit about Mormon crickets. I have learned that they always travel in swarms like the one we saw that day and that they devour all of the vegetation in their path as they move across the land. Of course, I have no idea what people who are familiar with these bugs experience as they see them marching toward their homes, but I imagine myself scurrying about in search of ways to eradicate the pests, or at the very least, create an impenetrable barrier between them and my front door.

At the risk of sounding melodramatic, I have begun to believe that Mormon crickets are an apt metaphor for my experiences over the past few months as I have navigated a number of “medical life changes.” I last wrote for this blog in September and at that time the surgery to implant my Intrathecal Baclofen pump was scheduled for late October. The day of my surgery I quelled my nervousness about “going under the knife” and presented myself in the same-day surgery department at a local hospital. After a flurry of activity that included the insertion of an IV, a blood draw for “typing” should I need a transfusion, and a number of other preparations, one of the surgeons who would be assisting with the procedure appeared at my bedside, lifted my gown to reveal my naked belly, and looked askance at a sore that festered there. Before he could even mark my body with his Sharpie, he left the room to phone the primary surgeon. Not long after that, she arrived at my bedside, examined the sore, and delivered the disappointing news that the surgery would have to be postponed.

That was the moment at which I began to learn about Methicillin-resistant Staphylococcus aureus (MRSA). I had, of course, heard of MRSA, but I thought of it as an extraordinarily rare infection that only afflicts people who have recently been hospitalized; I never once considered that I might acquire a MRSA infection, since I had not been hospitalized in years. I would learn, however, that MRSA is now more common than most people realize; while most cases of MRSA are still Hospital-Acquired (HA-MRSA), a growing percentage of cases fall into the category of Community-Acquired (CA-MRSA). My general practitioner said that the number of MRSA cases she treats in a year has increased manifold since she began practicing. The general surgeon who lanced the sores and collaborated with my general practitioner on treatment made a similar observation. In my case, the initial goal was to halt the MRSA outbreaks long enough to allow for the pump surgery and the post-surgical recovery period. An extended course of Clindamycin and Bactrim beat the MRSA “crickets” from my door long enough to achieve that goal, and by December, the infection was controlled enough to allow the surgery to go forward. After some discussion with the surgeon about where to locate the pump in order to avoid the sites where most of my MRSA outbreaks occur, I was cleared for a surgery that was—thankfully—uneventful.

The morning after the surgery (as soon as the anesthesia had worn off), I became aware of an excruciating pain in my left leg. I had heard from online friends who have had the surgery that they experienced very little pain afterward, so I began to wonder why the pain in my leg did not subside. To make a long story short, it seems that the catheter feeding baclofen from the pump into my spine was doing battle with one of my nerves. My understanding of the surgeon’s explanation (refer to the above admission about scant medical knowledge) is that the kind of pain I experienced occurs when the catheter comes to rest on a nerve. In my imagination, the nerve and the catheter are engaged in a battle for a prime position in my spine. Mostly because of my own stubbornness, I’ve not done a particularly good job of beating back these painful “crickets.” One of the common treatments for nerve pain is the drug Lyrica, and though I experienced relief from that medication, I was ultimately unwilling to accept its side effects, which for me included a general grogginess. In the end, I decided that I preferred the minimal relief of Ibuprofen to the grogginess I experienced with the more effective Lyrica.

At this point, the methodical process of calibrating the pump so that it functions at full capacity is underway, and I am in the capable hands of the nurse I have come to call The Goddess of all Things Pump. I am slowly becoming aware of pump’s benefits and less dependent for spasticity relief on oral medications. Not surprisingly, the MRSA has returned and I have begun another extended (6 months!) regimen of combined Clindamycin and Bactrim. The crickets, though, refuse to keep their distance. Perhaps due to the process of adjusting the medication I have developed an inexplicable intermittent shortness of breath. Though my normal breathing is fine, I am unable to take deep breaths without careful concentration and sometimes not even then. The physician who oversees the control of my pump says that he has seen similar situations in the past and lowering my pump dose temporarily has provided some relief. Thus, I assume that this nasty swarm of crickets will at some point be a red brown stain on the road to a fully functioning baclofen pump.

If you are like me, you have since the end of the third paragraph of this post wondered how those nasty little bugs got their odd name. Here’s what Professor Google has taught me: In 1848—the first spring after Brigham Young led the first band of Mormons into what is now Salt Lake City, Utah—the settlement’s crops were threatened with total destruction when a swarm of these bugs (which are not actually crickets, but katydids—a distinction only an entomologist could love) descended upon them and threatened the crops on which they depended for survival. According to the diaries of many of the Mormon settlers, in June of 1848 a mass of gulls (which are native to the Salt Lake area) arrived en masse and began eating the crickets. According to the tale, the birds ate, drank water, regurgitated, and kept eating until the bugs were eradicated. Some historians express doubt about the story’s accuracy; nonetheless, the myth has become known as the Miracle of the Gulls and it is an integral part of Utah’s history, and a Seagull Monument memorializing the event stands in Salt Lake City’s Temple Square, and the California gull is Utah’s state bird.

As always, your poignant stories are also poetic. I am so sad that you are in pain but am hopeful that the Goddess of All Things Pump (can she fix the running toilet in my house?) and the drugs will make you feel better. Lots of love–K

I am pretty sure that The Goddess of All Things Pump could probably fix your running toilet. Her talents seem quite extensive. If she can’t fix the toilet, then I am sure that some of the nurses I met on the Neurology floor of University Hospital this week could make quick work of it. :)

Yes, I think that they are a really extraordinary material reality for the people who live with them. And we midwesterners think that cicada years are bad! Thanks for the kind words about the writing. I have been following your blog and loving it, Susan.

Wonderfully written, terrific use of the bugs as metaphor. This whole damn disease is a swarm of Mormon crickets, sometimes ebbing but never stopping their relentless march towards… What? Oblivion, eventually, I suppose.

Glad that you have the pump working, and that the MRSA is under control. May the Goddess help keep the monsters at bay…

High praise coming from you, Marc. Yes, it does seem that this damn disease seems to march toward some unkown (and disturbing) destination. Makes me (and you, I am sure) wish there was more we could do about that!

I love you too, Sarah-Hope. I would be so happy to have an earthquake accomplish that goal! That said, I suspect that there are some folks in the states between here and there who would strongly oppose that plan. :)

That’s a good question. I am seeing some improvements in my spasticity. For instance, I was having what I think were back spasms (contractures in my lower back that made it difficult to move) every morning and usually once during the day. I haven’t had any of those since my last pump adjustment. I also think that my legs feel less spastic. If this kind of improvement continues, then I would say that it was a success.

Many of the difficulties I am having right now cannot necessarily be attributed to the pump. I would say that if a person is having extreme problems with spasticity, it makes sense to discuss the pump with her/his doctors. I will continue to consider and write about this question as the dosage on my pump is adjusted over the next few months.